• 文章类型: Journal Article
    背景:关于公众对当前公共卫生和社会措施(PHSMs)的偏好以及PHSMs下人们的心理健康的信息不足。
    目的:本研究旨在量化公众对不同PHSM的偏好,并测量中国COVID-19正常化阶段的大流行疲劳水平。
    方法:进行了一项具有离散选择实验和心理测量量表的全国性横断面研究,以评估公众对PHSM的偏好和态度,采用配额抽样法。使用COVID-19大流行疲劳量表(CPFS)筛查受访者的疲劳水平。多项式Logit模型,潜在类模型,采用Mann-Whitney检验进行统计分析。我们还进行了基于性别的亚组分析,年龄,月收入,心理健康状况,和大流行性疲劳状态。
    结果:中国共有689名受访者完成了调查。离散选择实验显示,受访者最重视3个月内感染COVID-19的风险(45.53%),其次是3个月内的收入损失(30.69%)。弱势群体(低收入人群和老年人)对感染风险更加敏感,而年轻的受访者对收入损失更敏感,更喜欢不暂停社交场所和交通工具。移民和患有大流行性疲劳的人对强制性加强疫苗接种和暂停运输的接受程度较低。此外,女性受访者的大流行疲劳水平更高,年轻的受访者,移民,和收入相对较低的受访者(CPFS与年龄的相关性:r=-0.274,P<.001;与月收入的相关性:r=-0.25,P<.001)。流行性疲劳程度较高的受访者也不喜欢强制加强COVID-19疫苗接种,而流行性疲劳程度较低的受访者更喜欢普遍的COVID-19加强疫苗接种。
    结论:大流行性疲劳在中国各地的受访者中广泛流行,在中国,在COVID-19正常化阶段,受访者希望恢复正常的社会生活,同时面临对COVID-19感染的恐惧。在未来的大流行期间,正确实施PHSMs应考虑居民的精神负担和依从性。
    BACKGROUND: Information on the public\'s preferences for current public health and social measures (PHSMs) and people\'s mental health under PHSMs is insufficient.
    OBJECTIVE: This study aimed to quantify the public\'s preferences for varied PHSMs and measure the level of pandemic fatigue in the COVID-19 normalization stage in China.
    METHODS: A nationwide cross-sectional study with a discrete choice experiment and psychometric scales was conducted to assess public preferences for and attitudes toward PHSMs, using the quota sampling method. The COVID-19 Pandemic Fatigue Scale (CPFS) was used to screen fatigue levels among respondents. The multinomial logit model, latent class model, and Mann-Whitney test were used for statistical analysis. We also conducted subgroup analysis based on sex, age, monthly income, mental health status, and pandemic fatigue status.
    RESULTS: A total of 689 respondents across China completed the survey. The discrete choice experiment revealed that respondents attached the greatest importance to the risk of COVID-19 infection within 3 months (45.53%), followed by loss of income within 3 months (30.69%). Vulnerable populations (low-income populations and elderly people) were more sensitive to the risk of infection, while younger respondents were more sensitive to income loss and preferred nonsuspension of social places and transportation. Migrants and those with pandemic fatigue had less acceptance of the mandatory booster vaccination and suspension of transportation. Additionally, a higher pandemic fatigue level was observed in female respondents, younger respondents, migrants, and relatively lower-income respondents (CPFS correlation with age: r=-0.274, P<.001; correlation with monthly income: r=-0.25, P<.001). Mandatory booster COVID-19 vaccination was also not preferred by respondents with a higher level of pandemic fatigue, while universal COVID-19 booster vaccination was preferred by respondents with a lower level of pandemic fatigue.
    CONCLUSIONS: Pandemic fatigue is widely prevalent in respondents across China, and respondents desired the resumption of normal social life while being confronted with the fear of COVID-19 infection in the normalization stage of COVID-19 in China. During future pandemics, the mental burden and adherence of residents should be considered for the proper implementation of PHSMs.
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  • 文章类型: Journal Article
    背景:在COVID-19大流行期间,世界各地的政府和公共卫生机构在互联网上遇到了社交媒体介导的信息流行病的困难。现有的公共卫生危机沟通策略需要更新。然而,在COVID-19大流行期间,世界各国政府和公共卫生机构的危机沟通经验尚未得到系统地汇编,需要更新的危机沟通策略。
    目的:本系统综述旨在收集和组织发件人的危机沟通经验(即,政府和公共卫生机构)在COVID-19大流行期间。我们的重点是探索政府和公共卫生机构经历的困难,在COVID-19大流行期间,政府和公共卫生机构在危机传播中的最佳做法,以及在未来公共卫生危机中应该克服的挑战。
    方法:我们计划于2024年5月1日开始文献检索。我们将搜索PubMed,MEDLINE,CINAHL,PsycINFO,心术,通讯摘要,和WebofScience。我们将过滤我们的数据库搜索从2020年及以后的搜索。我们将通过引用SPIDER(示例,兴趣现象,设计,评价,和研究类型)工具来搜索数据库中的摘要。我们打算包括政府和公共卫生机构对危机沟通的定性研究(例如,官员,工作人员,卫生专业人员,和研究人员)对公众。基于数据的定量研究将被排除在外。只有用英语写的论文将被包括在内。有关研究特征的数据,研究目的,参与者特征,方法论,理论框架,危机沟通的对象,并提取关键结果。将使用JoannaBriggs研究所关键评估清单对合格研究的方法学质量进行评估,以进行定性研究。共有两名独立审稿人将共同负责筛选出版物,数据提取,和质量评估。分歧将通过讨论解决,将咨询第三位审稿人,如有必要。调查结果将在表格和概念图中进行总结,并在描述性和叙述性审查中进行综合。
    结果:将以与我们的研究目标和兴趣相对应的方式系统地整合和呈现结果。我们预计此次审查的结果将于2024年底提交发布。
    结论:据我们所知,这将是对政府和公共卫生机构在COVID-19大流行期间向公众传达危机的经验的首次系统回顾。这项审查将有助于将来改进政府和公共卫生机构向公众传达危机的指南。
    背景:PROSPEROCRD42024528975;https://tinyurl.com/4fjmd8te。
    PRR1-10.2196/58040。
    BACKGROUND: Governments and public health agencies worldwide experienced difficulties with social media-mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies.
    OBJECTIVE: This systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises.
    METHODS: We plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data-based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review.
    RESULTS: The results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024.
    CONCLUSIONS: To our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public.
    BACKGROUND: PROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te.
    UNASSIGNED: PRR1-10.2196/58040.
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  • 文章类型: Journal Article
    一些报告表明,在COVID-19大流行期间,注意力缺陷/多动症(ADHD)症状有所增加。这项全国性的研究评估了在大流行之前和期间新的ADHD诊断和ADHD患病率。
    为了调查新的多动症诊断趋势,患病率,2015年至2022年在芬兰使用ADHD药物。
    这项纵向队列研究包括整个芬兰人口。ADHD的诊断和药物使用从全国范围的登记册中获得,并在3个时间点进行评估:2015年和大流行之前(2020年)和之后(2022年)。对2015年1月至2022年6月的数据进行了分析。
    新的多动症诊断,ADHD终生患病率,和多动症药物使用。
    该队列包括5572420人(2819645名女性[50.6%])。在2015年至2022年期间,ADHD的终生患病率增加了2.7倍;2015年患病率为1.02%(95%CI,1.01%-1.03%),2020年为1.80%(95%CI,1.79%-1.81%),和2022年的2.76%(95%CI,2.75%-2.77%)。2022年,13至20岁的年轻男性的终生患病率最高,为11.68%(95%CI,11.56%-11.81%)。在大流行期间,新的多动症诊断增加了一倍,从2020年的238/10万增加到2022年的477/10万。与大流行相关的新诊断增量为18.60%(95%CI,16.47%-20.49%;9482/50897例)。大流行期间,13至20岁的年轻女性的新诊断增加了2.6倍,从2020年的577/10万增加到2022年的1488/10万,21至30岁的女性增加了3.0倍,从361/100000到1100/100000。在55岁以上的人群中,新诊断增加了2.9倍(女性从每100000人中的5人增加到每100000人中的13人,男性从每100000人中的5人增加到每100000人中的14人)。2022年,13岁以下的男孩新发ADHD诊断的绝对比率最高(1745/100000)。但21岁以下的男孩和年轻男性在新诊断中并未显示出显著的增量增加.2015年ADHD药物购买的终生患病率为0.57%(95%CI,0.56%-0.58%)(诊断为ADHD的31771人[55.62%]),2020年1.15%(95%CI,1.14%-1.16%)(64034[63.83%]),2022年为1.69%(95%CI1.68%-1.70%)(92557[61.43%]),分别。
    在这项全国性的队列研究中,新的ADHD诊断和ADHD患病率在大流行期间在芬兰显著增加.与ADHD诊断相关,ADHD药物使用并未增加。这些结果突出了与大流行相关的生活条件变化的潜在不利结果。
    UNASSIGNED: Several reports suggest an increase in attention-deficit/hyperactivity disorder (ADHD) symptoms during the COVID-19 pandemic. This nationwide study assessed new ADHD diagnoses and ADHD prevalence before and during the pandemic.
    UNASSIGNED: To investigate trends in new ADHD diagnoses, prevalence, and ADHD medication use from 2015 to 2022 in Finland.
    UNASSIGNED: This longitudinal cohort study comprised the entire Finnish population. ADHD diagnoses and medication use were obtained from nationwide registers and assessed at 3 time points: in 2015 and before (2020) and after (2022) the pandemic. Data were analyzed from January 2015 to June 2022.
    UNASSIGNED: New ADHD diagnoses, ADHD lifetime prevalence, and ADHD medication use.
    UNASSIGNED: The cohort comprised 5 572 420 individuals (2 819 645 women [50.6%]). Lifetime prevalence of ADHD increased by 2.7-fold during 2015 to 2022; prevalence was 1.02% in 2015 (95% CI, 1.01%-1.03%), 1.80% in 2020 (95% CI, 1.79%-1.81%), and 2.76% in 2022 (95% CI, 2.75%-2.77%). Young men aged 13 to 20 years had the highest lifetime prevalence of 11.68% (95% CI, 11.56%-11.81%) in 2022. New ADHD diagnoses doubled during the pandemic, from 238 per 100 000 in 2020 to 477 per 100 000 in 2022. The pandemic-associated incremental increase in new diagnoses was 18.60% (95% CI, 16.47%-20.49%; 9482 per 50 897 cases). Young women aged 13 to 20 years had a 2.6-fold increase in new diagnoses during the pandemic, from 577 per 100 000 in 2020 to 1488 per 100 000 in 2022, and women aged 21 to 30 years had a 3.0-fold increase, from 361 per 100 000 to 1100 per 100 000. New diagnoses increased by 2.9-fold among those older than 55 years (from 5 per 100 000 to 13 per 100 000 in women and from 5 per 100 000 to 14 per 100 000 in men). Boys younger than 13 years had the highest absolute rate of new ADHD diagnoses in 2022 (1745 per 100 000), but boys and young men younger than 21 years did not show a significant incremental increase in new diagnoses. Lifetime prevalence of ADHD medication purchases was 0.57% (95% CI, 0.56%-0.58%) in 2015 (31 771 [55.62%] of those with ADHD diagnosis), 1.15% (95% CI, 1.14%-1.16%) in 2020 (64 034 [63.83%]), and 1.69% (95% CI 1.68%-1.70%) in 2022 (92 557 [61.43%]), respectively.
    UNASSIGNED: In this nationwide cohort study, new ADHD diagnoses and ADHD prevalence showed significant increase in Finland during the pandemic. ADHD medication use did not increase in relation to ADHD diagnoses. These results highlight potential adverse outcomes of pandemic-associated changes in living conditions.
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  • 文章类型: Journal Article
    感染艾滋病毒的青少年和年轻人(AYAs)性传播感染(STIs)的发生率很高。在冠状病毒病(COVID)大流行期间,性传播感染预防战略,包括使用测试/治疗设施,医护人员的可用性,和避孕套的可用性,可能已经减少了。这项研究旨在确定在亚特兰大感染艾滋病毒的AYAs队列中,首次感染和再感染的性传播感染发病率是否存在差异,GA.在GradyPonce诊所对所有13至24岁的患者进行了回顾性图表审查。确定了两个时代:前COVID时代(2009年1月1日至2019年12月31日)和COVID时代(2020年1月1日至2021年6月30日)。记录的性传播感染包括淋病,衣原体,人乳头瘤病毒,梅毒,滴虫,单纯疱疹病毒,性病淋巴肉芽肿,丙型肝炎,细菌性阴道病,还有软下体.报告了任何性传播感染的首次和复发发生率。我们的样本包括766例艾滋病毒性活跃的AYA。共有721名患者被纳入COVID前时代,583名(80.9%)患有至少一次性传播感染。共有337名患者被纳入COVID时代,和158至少有一个性传播感染(46.9%)。从COVID前期到COVID时代,首次性传播感染的总体发病率从每100人年42.47增加到58.67,复发性性传播感染的发病率从每100人年121.50增加到169.85(p<0.001)。我们的研究表明,在COVID时代,AYAs感染艾滋病毒的首次和复发性性传播感染的发病率明显更高。我们敦促继续现有的性传播感染预防计划,以避免感染增加的继发性临床和经济不利影响。
    Adolescents and young adults (AYAs) living with HIV have high rates of co-sexually transmitted infections (STIs). During the coronavirus disease (COVID) pandemic, STI prevention strategies, including access to testing/treatment facilities, availability of health care workers, and condom availability, may have decreased. This study aimed to determine if differences in STI incidence for first infection and reinfection existed between the pre-COVID and COVID eras in a cohort of AYAs living with HIV in Atlanta, GA. Retrospective chart review was conducted for all patients between ages 13 and 24 at the Grady Ponce Clinic. Two eras were identified: a pre-COVID era (January 1, 2009-December31, 2019) and a COVID era (January 1, 2020-June 30, 2021). STIs recorded included gonorrhea, chlamydia, human papillomavirus, syphilis, trichomonas, herpes simplex virus, lymphogranuloma venereum, hepatitis C, bacterial vaginosis, and chancroid. First and recurrent incidence rates for any STIs were reported. Our sample included 766 sexually active AYAs with HIV. A total of 721 patients were included in the pre-COVID era and 583 (80.9%) had at least one STI. A total of 337 patients were included in the COVID era, and 158 had at least one STI (46.9%). The overall first STI incidence rate increased from 42.47 to 58.67 per 100 person-years (PY) and the recurrent STI incidence rate increased from 121.50 to 169.85 per 100 PY from the pre-COVID to the COVID era (p < 0.001). Our study demonstrated significantly higher incidence rates of first and recurrent STIs in AYAs living with HIV in the COVID era. We urge continuation of existing STI prevention programs to avoid secondary clinical and economic adverse effects of increased infections.
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  • 文章类型: English Abstract
    Herpes zoster (HZ) is a common disease caused by reactivation of varicella zoster virus. Diagnosis is usually based on the typical clinical presentation. Standard treatment includes antiviral, topical and analgesic therapies. As a complication, postherpetic neuralgia (PHN) can result from acute HZ infection, particularly in older and/or immunocompromised people. This can seriously impair the quality of life of those affected and requires adequate analgesia. In addition to the genesis, clinical presentation and treatment recommendations for HZ and PHN, this article also deals in particular with the vaccination prophylaxis recommended by the standing vaccination commission of the Robert Koch Institute (STIKO).
    UNASSIGNED: Der Herpes zoster (HZ) ist ein häufiges Krankheitsbild, das durch die Reaktivierung des Varicella-Zoster-Virus (VZV) ausgelöst wird. Die Diagnosestellung erfolgt in der Regel anhand der typischen Klinik. Die Standardbehandlung umfasst antivirale, topische und analgetische Therapien. Als Komplikation kann insbesondere bei älteren und/oder immunkompromittierten Personen aus der akuten HZ-Infektion eine postherpetische Neuralgie (PHN) resultieren. Diese kann die Lebensqualität Betroffener stark kompromittieren und bedarf einer adäquaten Analgesie. Neben Genese, Klinik und Therapieempfehlungen von HZ und PHN befasst sich dieser Beitrag insbesondere auch mit der seitens der Ständigen Impfkommission (STIKO) des Robert Koch-Instituts empfohlenen Impfprophylaxe.
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  • 文章类型: Journal Article
    OBJECTIVE: A large number of patients with olfactory impairment are affected by parosmia or phantosmia. This study aimed to examine the demographic and clinical characteristics of parosmia.
    METHODS: We performed a retrospective data analysis of patients consulting at our Smell and Taste Outpatient Clinic. A total of 297 patients were included (203 women, mean age 44.4 ± 13.7 years). Olfactory function was quantified using the \"Sniffin\' Sticks\" composite TDI (odor threshold, determination, and identification) score. The presence of qualitative olfactory impairment was assessed trough medical history and a parosmia questionnaire.
    RESULTS: Most of the patients showed olfactory impairment after an infection with SARS-CoV‑2 (84%) and were diagnosed with parosmia (49%). Patients with parosmia (PAR) (n = 201) were significantly younger compared to the group without parosmia (noPAR; n = 92) (PAR 43.2 ± 13 years vs. noPAR 47 ± 15.1 years, p = 0.03) and had a slightly shorter duration of disease, without reaching statistical significance (PAR 10.3 ± 4.9 months, noPAR 13.6 ± 37.6 months, p = 0.23). They also had higher TDI scores (PAR 24.3 ± 7 points, noPAR 21.4 ± 8.2 points, p = 0.003).
    CONCLUSIONS: Patients affected by parosmia were younger and had a better olfactory function compared to patients without parosmia.
    UNASSIGNED: ZIELSETZUNGEN: Eine große Anzahl von Patient:innen mit Riechstörungen ist von Parosmie oder Phantosmie betroffen. Ziel dieser Studie war es, die demografischen und klinischen Merkmale der Parosmie zu untersuchen.
    METHODS: Die Autor:innen haben eine retrospektive Datenanalyse von Patient:innen durchgeführt, die in der Riech- und Geschmacksambulanz der Klinik der Autor:innen behandelt wurden. Insgesamt wurden 297 Patient:innen in die Studie eingeschlossen (203 Frauen, Durchschnittsalter 44,4 ± 13,7 Jahre). Die Riechfunktion wurde anhand des SDI-Werts (Schwellenwert, Diskrimination und Identifikation) der „Sniffin’ Sticks“ quantifiziert. Das Vorhandensein einer qualitativen Riechstörung wurde mittels der Krankengeschichte und eines Parosmie-Fragebogens ermittelt.
    UNASSIGNED: Die meisten Patient:innen wiesen nach einer Infektion mit SARS-CoV‑2 eine Riechstörung auf (84 %), und bei ihnen wurde eine Parosmie diagnostiziert (49 %). Die Patient:innen mit Parosmie (PAR; n = 201) waren signifikant jünger als die Gruppe ohne Parosmie (noPAR; n = 92; PAR 43,2 ± 13 Jahre vs. noPAR 47 ± 15,1 Jahre; p = 0,03) und hatten eine etwas kürzere Krankheitsdauer, ohne dass dies statistisch signifikant war (PAR 10,3 ± 4,9 Monate; noPAR 13,6 ± 37,6 Monate; p = 0,23). Sie wiesen höhere SDI-Werte auf (PAR 24,3 ± 7 Punkte; noPAR 21,4 ± 8,2 Punkte; p = 0,003).
    UNASSIGNED: Die von Parosmie betroffenen Patient:innen waren jünger und hatten eine bessere Riechfunktion als Patient:innen ohne Parosmie. .
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  • 文章类型: Journal Article
    面罩的存在可以显著影响与来自面部的特质印象相关的过程。在目前的研究中,我们通过解决上下文因素如何影响这些推论来关注戴口罩或不戴口罩的面孔的特质印象。在研究1中,我们比较了COVID-19大流行阶段的面部特征印象,在该阶段,戴口罩是一种规范行为(T1),与一年后戴口罩不太常见(T2)评估的特征印象进行了比较。T2时的结果显示,面具覆盖的面孔引起的特质印象的阳性降低。在研究2中,发现面部的特质印象是由嵌入目标面部的背景视觉环境调制的,因此戴口罩的面部在叠加在室内而不是室外视觉环境上时会产生更多的积极特质。总的来说,目前的研究表明,戴口罩可能会影响面部的特质印象,而且这种印象是高度灵活的,并且可能在时间和空间上发生重大波动。
    The presence of face masks can significantly impact processes related to trait impressions from faces. In the present research, we focused on trait impressions from faces either wearing a mask or not by addressing how contextual factors may shape such inferences. In Study 1, we compared trait impressions from faces in a phase of the COVID-19 pandemic in which wearing masks was a normative behavior (T1) with those assessed one year later when wearing masks was far less common (T2). Results at T2 showed a reduced positivity in the trait impressions elicited by faces covered by a mask. In Study 2, it was found that trait impressions from faces were modulated by the background visual context in which the target face was embedded so that faces wearing a mask elicited more positive traits when superimposed on an indoor rather than outdoor visual context. Overall, the present studies indicate that wearing face masks may affect trait impressions from faces, but also that such impressions are highly flexible and can significantly fluctuate across time and space.
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  • 文章类型: Journal Article
    背景:先前的回顾性研究表明,在患有COVID-19相关急性呼吸窘迫综合征(ARDS)的插管患者中,平均保持俯卧位(PP)40小时与生存率的提高有关。这项研究旨在确定与32小时或更短的累积PP持续时间相比,在重症监护病房(ICU)入院的前2天,累积PP持续时间超过32小时是否与生存率增加相关。
    方法:本研究是对先前一项大型国际观察性研究的辅助分析,该研究涉及在法国149个ICU中,在ICU入院的前48小时内将插管患者置于PP中,比利时和瑞士。鉴于PP建议每天持续16小时,强化PP定义为在最初48小时内累积持续时间超过32小时,而标准PP定义为持续时间等于或小于32小时。患者随访90天。主要结果是第60天的死亡率。使用包括目标仿真试验方法的逆概率审查加权(IPCW)Cox模型来分析数据。
    结果:在2137名插管患者中,在ICU入院的前48小时内,将753人置于PP中。强化PP组(n=79)的中位PP持续时间为36小时,而标准PP组(n=674)在前48h的中位数为16h。强化PP组的60天死亡率为39.2%,而标准PP组为38.7%(p=0.93)。两组的28天和90天死亡率以及直到第28天的无呼吸机天数相似。在IPCW之后,两个研究组在第60天的死亡率没有显着差异(HR0.95[0.52-1.74],p=0.87和HR1.1[0.77-1.57],在完整案例分析或多重插补分析中,p=0.61,分别)。
    结论:这项对欧洲大型多中心队列研究的二次分析发现,与标准PP相比,在最初48小时内强化PP没有提供生存益处。
    BACKGROUND: Previous retrospective research has shown that maintaining prone positioning (PP) for an average of 40 h is associated with an increase of survival rates in intubated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit (ICU) admission is associated with increased survival compared to a cumulative PP duration of 32 h or less.
    METHODS: This study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in 149 ICUs across France, Belgium and Switzerland. Given that PP is recommended for a 16-h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day 60. An Inverse Probability Censoring Weighting (IPCW) Cox model including a target emulation trial method was used to analyze the data.
    RESULTS: Out of 2137 intubated patients, 753 were placed in PP during the first 48 h of ICU admission. The intensive PP group (n = 79) had a median PP duration of 36 h, while standard PP group (n = 674) had a median of 16 h during the first 48 h. Sixty-day mortality rate in the intensive PP group was 39.2% compared to 38.7% in the standard PP group (p = 0.93). Twenty-eight-day and 90-day mortality as well as the ventilator-free days until day 28 were similar in both groups. After IPCW, there was no significant difference in mortality at day 60 between the two-study groups (HR 0.95 [0.52-1.74], p = 0.87 and HR 1.1 [0.77-1.57], p = 0.61 in complete case analysis or in multiple imputation analysis, respectively).
    CONCLUSIONS: This secondary analysis of a large multicenter European cohort of intubated patients with ARDS due to COVID-19 found that intensive PP during the first 48 h did not provide a survival benefit compared to standard PP.
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  • 文章类型: Journal Article
    背景:COVID-19大流行引起了临床医生的关注,特别是抗CD20单克隆抗体(mAb)和芬戈莫德,可能会使多发性硬化症(pwMS)患者的COVID-19恶化。这项研究旨在检查DMT在大流行发作前后的处方趋势。
    方法:对来自MSBase的8,771名参与者进行了一项多中心纵向研究。定义了两个时间段:大流行前(2018年3月11日至2020年3月10日)和大流行后(2020年3月11日至2022年3月11日)。使用多变量混合效应逻辑回归分析时间和处方趋势之间的关联。DMT启动是指任何DMT的首次启动,而DMT开关表明在最后一次使用后6个月内改变方案。
    结果:大流行发作后,DMT开始/转换为那他珠单抗和克拉屈滨的显着增加[(那他珠单抗开始:OR1.72,95%CI1.39-2.13;转换:OR1.66,95%CI1.40-1.98),(克拉屈滨起始:OR1.43,95%CI1.09-1.87;转换:OR1.67,95%CI1.41-1.98)]。抗CD20mAb启动/转换在大流行的年份减少,但是在第二年恢复了,这样,大流行后的总体几率略有增加(开始:OR1.26,95%CI1.06-1.49;转换:OR1.15,95%CI1.02-1.29。芬戈莫德的启动/切换,干扰素-β,和阿仑单抗显着降低[(芬戈莫德开始:OR0.55,95%CI0.41-0.73;转换:OR0.49,95%CI0.41-0.58),(干扰素-γ起始:OR0.48,95%CI0.41-0.57;转换:OR0.78,95%CI0.62-0.99),(阿仑珠单抗起始:OR0.27,95%CI0.15-0.48;转换:OR0.27,95%CI0.17-0.44)]。
    结论:大流行发作后,临床医生优先使用那他珠单抗和克拉屈滨,而不是抗CD20单克隆抗体和芬戈莫德,可能保持疗效,但降低感知的免疫抑制风险。这可能对pwMS中的疾病进展有影响。我们的发现强调了全球公平的DMT准入的重要性,以及循证决策在全球卫生挑战中的重要性。
    BACKGROUND: The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (DMT), particularly anti-CD20 monoclonal antibodies (mAb) and fingolimod, could worsen COVID-19 in people with multiple sclerosis (pwMS). This study aimed to examine DMT prescribing trends pre- and post-pandemic onset.
    METHODS: A multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018-March 10 2020) and post-pandemic onset (March 11 2020-11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use.
    RESULTS: Post-pandemic onset, there was a significant increase in DMT initiation/switching to natalizumab and cladribine [(Natalizumab-initiation: OR 1.72, 95% CI 1.39-2.13; switching: OR 1.66, 95% CI 1.40-1.98), (Cladribine-initiation: OR 1.43, 95% CI 1.09-1.87; switching: OR 1.67, 95% CI 1.41-1.98)]. Anti-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (initiation: OR 1.26, 95% CI 1.06-1.49; Switching: OR 1.15, 95% CI 1.02-1.29. Initiation/switching of fingolimod, interferon-beta, and alemtuzumab significantly decreased [(Fingolimod-initiation: OR 0.55, 95% CI 0.41-0.73; switching: OR 0.49, 95% CI 0.41-0.58), (Interferon-gamma-initiation: OR 0.48, 95% CI 0.41-0.57; switching: OR 0.78, 95% CI 0.62-0.99), (Alemtuzumab-initiation: OR 0.27, 95% CI 0.15-0.48; switching: OR 0.27, 95% CI 0.17-0.44)].
    CONCLUSIONS: Post-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges.
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  • 文章类型: Journal Article
    The COVID-19 epidemic has made significant changes in the organization of treatment process both at the inpatient and outpatient stages.
    OBJECTIVE: To analyze the work results of the rehabilitation units dealing with patients who have suffered from COVID-19, in order to summarize the used approaches to medical rehabilitation and improve the effectiveness of care delivery in the recovery phase.
    CONCLUSIONS: Currently, the rehabilitation system has been effectively rebuilt to meet new challenges of the COVID-19 pandemic. Recovery of patients with pronounced neurotic disorders has become a showing good results direction in rehabilitation. It is necessary to implement a tight integration of physical exercises and telerehabilitation facilities in order to effectively settle the main issues directly related to the treatment and recovery of patients with COVID-19 and other pathologies. The control, prevention, treatment and rehabilitation of other infectious diseases will have great prospects regarding the possibility of remote follow-up of patients and correction of their functional state of the body in the nearest future.
    Эпидемия COVID-19 внесла существенные коррективы в организацию лечебного процесса как на стационарном, так и на амбулаторном этапах.
    UNASSIGNED: Провести анализ результатов работы реабилитационных подразделений, занимающихся пациентами, перенесшими COVID-19, с целью обобщения применяемых подходов к медицинской реабилитации и повышения эффективности оказания помощи на этапе восстановления.
    UNASSIGNED: В настоящее время система реабилитации эффективно перестроилась под новые вызовы пандемии COVID-19. Направлением в реабилитации, демонстрирующим хорошие результаты, стало восстановление пациентов с выраженными невротическими расстройствами. Для эффективного решения основных вопросов, непосредственно связанных с лечением и восстановлением пациентов с COVID-19 и другими патологиями, необходимо осуществить плотную интеграцию физических упражнений и средств телереабилитации. В ближайшем будущем контроль, профилактика, лечение и реабилитация других инфекционных заболеваний будут иметь большие перспективы в отношении возможности дистанционного динамического наблюдения за пациентами и коррекции их функционального состояния организма.
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